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Definitive Care for Severely Injured Children in Quebec

  • Mélyssa Fortin
    Affiliations
    McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
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  • Zoe Atsaidis
    Affiliations
    McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
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  • Brent Hopkins
    Affiliations
    Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4
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  • Etienne St-Louis
    Affiliations
    Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4

    Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
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  • Elena Guadagno
    Affiliations
    Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
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  • Debbie Friedman
    Affiliations
    Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Canadian Hospitals Injury Reporting and Prevention Program, Public Health Agency of Canada, Department of Pediatrics and Department of Pediatric Surgery, Faculty of Medicine and Health Sciences McGill University
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  • Dan Poenaru
    Correspondence
    Corresponding author at: Dan Poenaru, 1001 Décarie Boulevard Room B04.2439.1, Montreal, Quebec, Canada. H4A3J1.
    Affiliations
    Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
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      Highlights

      • Injury remains the leading and most common cause of death in children above the age of one in Quebec.
      • In Northern Quebec, injury is the leading cause of death in children, occurring at a rate that is 3 to 4 times higher than the national average.
      • Patients from Northern Quebec were significantly more likely to experience a longer length of hospitalization than their counterparts.
      • A more sophisticated pre-hospital trauma system allowing for better and culturally sensitive treatment of patients from all of Quebec is needed.

      Abstract

      Introduction

      Injury is the leading cause of death in children over the age of one in Canada, and remains the most common cause of death in Quebec pediatric patients. Indigenous communities are 3–4 times more likely to be affected by injuries than the national average. In Quebec, health centres can range from 30 to 1000 km away from the closest level I trauma center.

      Methods

      Descriptive analysis and multiple logistic regression were performed for severely injured pediatric trauma patients received at the Montreal Children's Hospital (MCH) over a ten-year period. Outcomes were compared between regional groups in Quebec using forward sortation areas.

      Results

      Two hundred and forty four pediatric patients presented to the MCH with major trauma between 2006 and 2016. Of those, 42% of patients resided in Montreal, 42% off-island, and 16% in Northern Quebec. Admission to the Intensive Care Unit (ICU) was required for 60% of off-island patients and 58% of Northern residents. The median length of hospital stay (LOS) was 5 days for off-island and 15 days for Northern patients. Most patients (78% off-island vs. 76% Northern Quebec) were discharged home. The overall mortality was 5%. In multiple regression analysis, residence in Northern Quebec was associated with increased incidence of longer than median length of stay compared to off-island patients (OR 2.78, 95%CI (1.12–7.29)) after adjusting for injury severity, operative intervention, age, and sex.

      Conclusion

      ICU admission rate was similar among Northern and off-island populations. Patients from Northern Quebec appeared to have longer-than-median hospital length of stay. In-hospital mortality was infrequent and limited to on-island and off-island populations. A further exploration of this data is required to identify the “trauma deserts” and advocate for children involved in trauma in all areas of Quebec.

      Keywords

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      References

        • Odetola F.O.
        • Mann N.C.
        • Hansen K.W.
        • Bratton S.L.
        Factors associated with time to arrival at a regional pediatric trauma center.
        Prehosp Disaster Med. 2016; 31: 4-9
        • West J.G.
        • Trunkey D.D.
        • Lim R.C.
        Systems of trauma care. A study of two counties.
        Arch Surg. 1979; 114: 455-460
        • West J.G.
        • Cales R.H.
        • Gazzaniga A.B.
        Impact of regionalization. The Orange County experience.
        Arch Surg. 1983; 118: 740-744
        • Shackford S.R.
        • Hollingworth-Fridlund P.
        • Cooper G.F.
        • Eastman A.B.
        The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report.
        J Trauma. 1986; 26: 812-820
        • Newgard C.D.
        • McConnell K.J.
        • Hedges J.R.
        • Mullins R.J.
        The benefit of higher level of care transfer of injured patients from Nontertiary hospital emergency departments.
        J Trauma. 2007; 63: 965-971
        • Birken C.S.
        • Parkin P.C.
        • To T.
        • Macarthur C.
        Trends in rates of death from unintentional injury among Canadian children in urban areas: influence of socioeconomic status.
        CMAJ. 2006; 175: 867
        • Amini R.
        • Lavoie A.
        • Moore L.
        • Sirois M.J.
        • Emond M.
        Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system.
        J Emerg Trauma Shock. 2011; 4: 12-19https://doi.org/10.4103/0974-2700.76824
      1. Gouvernement du Québec. Profile of the nations. n.d. https://www.quebec.ca/en/government/quebec-at-a-glance/first-nations-and-inuit/profile-of-the-nations. Accessed September 26, 2021.

      2. RUISSS McGill. Territory. n.d. https://www.mcgill.ca/ruisss/territory. Accessed September 20, 2021.

        • Government of Canada. Quebec
        Natural resources canada, atlas of canada.
        6th Edition. 2017 (Series Issue ID 6933. License) (Accessed January 23rd, 2022)
        • Banerji A.
        Canadian Paediatric Society, First Nations, Inuit and Métis Health Committee. Preventing unintentional injuries in Indigenous children and youth in Canada.
        Paediatr Child Health. 2012; 17: 393-394
        • Pike I.
        • McDonald R.J.
        • Piedt S.
        • Macpherson A.K.
        Developing injury indicators for First Nations and Inuit children and youth in Canada: a modified Delphi approach.
        Chronic Dis Inj Can. 2014; 34: 203-209
        • Muelleman R.L.
        • Wadman M.C.
        • Tran T.P.
        • Ullrich F.
        • Anderson J.R.
        Rural motor vehicle crash risk of death is higher after controlling for injury severity.
        J Trauma. 2007; 62: 221-226
        • Peek-Asa C.
        • Zwerling C.
        • Stallones L.
        Acute traumatic injuries in rural populations.
        Am J Public Health. 2004; 94: 1689-1693
        • Crandall M.
        • Sharp D.
        • Unger E.
        • Straus D.
        • Brasel K.
        • Hsia R.
        • et al.
        Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago.
        Am J Public Health. 2013; 103: 1103-1109
        • Lawson F.L.
        • Schuurman N.
        • Oliver L.
        • Nathens A.B.
        Evaluating potential spatial access to trauma center care by severely injured patients.
        Health Place. 2013; 19: 131-137
        • Carr B.G.
        • Nance M.L.
        Access to pediatric trauma care: alignment of providers and health systems.
        Curr Opin Pediatr. 2010; 22: 326-331
        • Mitchell R.J.
        • Curtis K.
        • Chong S.
        • Holland A.J.
        • Soundappan S.V.
        • Wilson K.L.
        • et al.
        Comparative analysis of trends in paediatric trauma outcomes in New South Wales.
        Australia. Injury. 2013; 44: 97-103
      3. Direction générale des services de santé et de médecine universitaire du ministère de la Santé et des Services sociaux du Québec. Cadre normatif - système d'information du registre des traumatismes du Québec (SIRTQ). https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21_CN-SIRTQ.pdf Accessed July 27th, 2021.

        • Champion H.R.
        • Copes W.S.
        • Sacco W.J.
        • Lawnick M.M.
        • Keast S.L.
        • Bain L.W.
        • et al.
        The major trauma outcome study: establishing national norms for trauma care.
        J Trauma. 1990; 30: 1356-1365
        • Moller H.
        • Falster K.
        • Ivers R.
        • Jorm L.
        Inequalities in unintentional injuries between indigenous and non-indigenous children: a systematic review.
        Inj Prev. 2015; 21: e144-e152
        • Margeson A.
        • Gray S.
        Interventions Aimed at the Prevention of Childhood Injuries in the Indigenous Populations in Canada, Australia and New Zealand in the Last 20 Years: a Systematic Review.
        Int J Environ Res Public Health. 2017; 14: 589
        • Carson E.
        • Sharmin S.
        • Maier A.B.
        • Meij J.J.
        Comparing indigenous mortality across urban, rural and very remote areas: a systematic review and meta-analysis.
        Int Health. 2018; 10: 219-227
        • Fraser S.L.
        • Gaulin D.
        • Fraser W.D.
        Dissecting systemic racism: policies, practices and epistemologies creating racialized systems of care for Indigenous peoples.
        Int J Equity Health. 2021; 20 (Published 2021 Jul 14): 164https://doi.org/10.1186/s12939-021-01500-8
        • Hamadani F.
        Demographic and population-based analysis of traumatic injury transport outcomes and health-care infrastructure in Northern Québec's rural communities.
        McGill University Library., 2014 (Accessed at escholarship.mcgill.ca)
        • Lemchuk-Favel L.
        • Jock R
        Aboriginal health systems in Canada: nine case studies.
        J Aborig Health. 2004; 1: 28-51
        • Hordyk S.R.
        • Macdonald M.E.
        • Brassard P.
        Inuit interpreters engaged in end-of-life care in Nunavik, Northern Quebec.
        Int J Circumpolar Health. 2017; 761291868
        • Vigneault L.P.
        • Diendere E.
        • Sohier-Poirier C.
        • Abi H.M.
        • Poirier A.
        • St-Onge M.
        Acute health care among Indigenous patients in Canada: a scoping review.
        Int J Circumpolar Health. 2021; 801946324https://doi.org/10.1080/22423982.2021.1946324
        • Stroud M.H.
        • Prodhan P.
        • Moss M.M.
        • Anand K.J.
        Redefining the golden hour in pediatric transport.
        Pediatr Crit Care Med. 2008; 9: 435-437
        • Lechman C.
        • Duder S.
        Hospital length of stay: social work services as an important factor.
        Soc Work Health Care. 2009; 48: 495-504
        • Kolahdooz F.
        • Nader F.
        • Yi K.J.
        • Sharma S.
        Understanding the social determinants of health among Indigenous Canadians: priorities for health promotion policies and actions.
        Glob Health Action. 2015; 8: 27968
        • Fleet R.
        • Lauzier F.
        • Tounkara F.K.
        • Turcotte S.
        • Poitras J.
        • Morris J.
        • et al.
        Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study.
        BMJ Open. 2019; 9: e02851